Risk Factors for Reoperation in Vitrectomy for Stage 4A Retinopathy of Prematurity
Masaki Fukushima1, Chiharu Iwahashi2, Tomoki Kurihara3
1Department of Ophthalmology, Kindai University Faculty of Medicine, Osaka, Japan; Department of Ophthalmology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan.
Ophthalmology. Retina
|May 11, 2025
Summary
Vitrectomy for stage 4A retinopathy of prematurity (ROP) achieves high success rates. However, plus disease, extensive fibrovascular membranes, and significant fluorescein leakage increase reoperation risk, while anti-VEGF therapy may reduce reoperations for vitreous hemorrhage.
Area of Science:
- Ophthalmology
- Neonatal Care
- Surgical Innovation
Background:
- Retinopathy of prematurity (ROP) is a leading cause of blindness in premature infants.
- Stage 4A ROP requires surgical intervention, often vitrectomy, to prevent irreversible vision loss.
- Identifying risk factors for reoperation after vitrectomy is crucial for optimizing patient outcomes.
Purpose of the Study:
- To identify risk factors associated with reoperation following vitrectomy for stage 4A retinopathy of prematurity (ROP).
- To evaluate the effectiveness of preoperative anti-VEGF therapy in reducing reoperation rates in specific ROP cases.
Main Methods:
- Retrospective comparative case series including 132 eyes of 90 patients with stage 4A ROP undergoing vitrectomy between 2010 and 2023.
- Data collected included patient demographics, ROP stage, surgical details, and postoperative complications such as vitreous hemorrhage and redetachment.
- Multivariable logistic regression analysis was used to determine risk factors for reoperation.
Main Results:
- High anatomical success rate (97%) was achieved with vitrectomy.
- Reoperations were required for postoperative vitreous hemorrhage (23%) and redetachment (6%).
- Plus disease, greater fibrovascular membrane extent, and higher fluorescein leakage grade were significant risk factors for reoperation. Preoperative anti-VEGF therapy reduced reoperation for vitreous hemorrhage in eyes with plus disease (P=0.002).
Conclusions:
- Vitrectomy is effective for stage 4A ROP, but certain factors increase reoperation risk.
- Plus disease, extensive fibrovascular membranes, and high fluorescein leakage necessitate careful monitoring and management.
- Preoperative anti-VEGF therapy shows promise in mitigating reoperation rates for vitreous hemorrhage in eyes with plus disease.
